ISSN CIENTIFIC OURNAL ACTA SALUS VITAE. Volume 1 - Number 1, COLLEGE OF PE AND SPORT, PALESTRA Ltd. & SOCIETY OF RESEARCH IN WELLNESS

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1 ISSN S J CIENTIFIC OURNAL ACTA SALUS VITAE Volume 1 - Number 1, 2013 COLLEGE OF PE AND SPORT, PALESTRA Ltd. & SOCIETY OF RESEARCH IN WELLNESS

2 Scientific Journal Acta Salus Vitae Volume 1, Number 1, 2013 Editor College of Physical Education and Sport PALESTRA, Prague, Czech Republic & Society of Research in Wellness Prague, Czech Republic, 2013 College of Physical Education and Sport PALESTRA Pilská 9, Prague 9 Hostavice, , Czech Republic ISSN Vysoká škola tělesné výchovy a sportu PALESTRA, spol. s r. o.

3 SCIENTIFIC BOARD Prof. PaedDr. Pavol BARTIK, Ph.D. (University of Matej Bell, Banska Bystrica, Slovak Republic) Prof. Eugeniusz BOLACH, Ph.D. (College of Physical Education, Wroclaw, Poland) Prof. Shivah GHOSH, Ph.D. (Himachal University, Shimla, India) Prof. Tetsuo HARADA, Ph.D., (Kochi University, Kochi,Japan) Assoc. Prof. PhDr. Běla HÁTLOVÁ, Ph.D. (University of Jan Evangelista Purkyně, Ústí nad Labem, Czech Republic) Prof. PhDr. Anna HOGENOVÁ, Ph.D. (Charles University, Prague, Czech Republic) Prof. PhDr. Václav HOŠEK, DrSc. (College of Physical Education and Sport PALESTRA, Prague, Czech Republic) Assoc. Prof. MUDr. Dobroslava JANDOVÁ, Ph.D. Teaching Hospital Královské Vinohrady, Charles University, Prague, Czech Republic) Assoc. Prof. PaedDr. Milada KREJČÍ, Ph.D. (College of Physical Education and Sport PALESTRA, Prague, Czech Republic) Assoc. Prof. PhDr. Jan NEUMAN, Ph.D. (College of Physical Education and Sport PALESTRA, Prague, Czech Republic) Dr. hab. Beata PITULA, Ph.D. (Uniwersita Śląski, Katowice, Poland) Dr. Peter REHOR, Ph.D. (Centre for Sport and Exercise Education Pacific Institute for Sport Excellence Camosun College, Vancouver, Canada) Prof., dr. hab. Wiesława A. SACHER, Ph.D. (Uniwersita Śląski,Katowice, Poland) PhDr. Markéta ŠAUEROVÁ, Ph.D. (College of Physical Education and Sport PALESTRA, Prague, Czech Republic) Assoc. Prof. PhDr. Pavel TILINGER, Ph.D. (College of Physical Education and Sport PALESTRA, Prague, Czech Republic) Prof. Kailash TULI, Ph.D. (Delhi University, Delhi, India) PhDr. Ludmila VACKOVÁ, Ph.D. (Canadian Tourism College, Vancouver, Canada) Prof. PhDr. Alena VALIŠOVÁ, CSc. (Univerzita Pardubice, Pardubice, Česká republika) Assoc. Prof. PaedDr. Mojmír VÁŽANSKÝ, Ph.D. (The Institute of Lifelong Education, University of Masaryk, Brno, Czech Republic) Editorial in chef PhDr. Markéta Šauerová, Ph.D. Technical editor Bc. Tereza Havlová - 2 -

4 VĚDECKÁ RADA ČASOPISU prof. PaedDr. Pavol BARTIK, Ph.D. (Univerzita Máteja Bella, Bánska Bystrica, Slovenská republika) prof. Eugeniusz BOLACH, Ph.D. (Akademia Wychowania Fizycznego, Wroclaw, Polsko) prof. Shivah GHOSH, Ph.D. (Himachal University, Shimla, Indie) prof. Tetsuo HARADA, Ph.D., (Kochi University, Kochi, Japonsko) doc. PhDr. Běla HÁTLOVÁ, Ph.D. (Univerzita Jana Evangelisty Purkyně, Ústí nad Labem, Česká republika) prof. PhDr. Anna HOGENOVÁ, CSc. (Univerzita Karlova, Praha, Česká republika) prof. PhDr. Václav HOŠEK, DrSc. (VŠTVS PALESTRA, Praha, Česká republika) doc. MUDr. Dobroslava JANDOVÁ, CSc. (Fakultní nemocnice Královské Vinohrady, Univerzita Karlova, Praha, Česká republika) doc. PaedDr. Milada KREJČÍ, CSc. (VŠTVS PALESTRA, Praha, Česká republika) doc. PhDr. Jan NEUMAN, CSc. (VŠTVS PALESTRA, Praha, Česká republika) Dr. hab. Beata PITULA, Ph.D. (Uniwersita Śląski, Katowice, Polsko) Dr. Peter REHOR, Ph.D. (Centrum sportu a tělesné výchovy, Pacific Institute for Sport Excellence Camosun College,Vancouver, Kanada) prof., dr. hab. Wiesława A. SACHER, Ph.D. (Uniwersita Śląski, Katowice, Polsko) PhDr. Markéta ŠAUEROVÁ, Ph.D. (VŠTVS PALESTRA, Praha, Česká republika) doc. PhDr. Pavel TILINGER, CSc. (VŠTVS PALESTRA, Praha, Česká republika) Prof. Kailash TULI, Ph.D. (Delhi University, Delhi, Indie) PhDr. Ludmila VACKOVÁ, Ph.D. (Canadian Tourism College, Vancouver, Kanada) Prof. PhDr. Alena VALIŠOVÁ, CSc. (Univerzity of Pardubice, Pardubice, Czech Republic) doc. PaedDr. Mojmír VÁŽANSKÝ, CSc. (Institut celoživotního vzdělávání MU Brno, Brno, Česká republika) Vedoucí redaktor PhDr. Markéta Šauerová, Ph.D. Technický redaktor Bc. Tereza Havlová - 3 -

5 CONTENT Preface/Introduction Peter R. Rehor Yes I Can Exercise Adoption/Adherence Model Tetsuo Harada Education to healthy life style with the accent to sleep habits intervention programs...13 Václav Hošek Wellness, Well-being and Physical Activity Dobroslava Jandová Wellness in Spa Medicin...34 Jan Neuman Wellness and Outdoor Activities.. 39 Daniela Stackeová Current Trends in Fitness and The Signification for Wellness Radka Střeštíková a Zora Svobodová A Comparison of Motivation to Physical Activity of Women in Selected Age Groups...53 Jaroslav Potměšil Welness as the Prevention of Syndrom of Geriatric Frailty Markéta Šauerová The Wellness Activities in the Ageing Process

6 OBSAH Předmluva...6 Peter R. Rehor Ano, mohu cvičit, přijetí a realizace modelu...7 Tetsuo Harada Výchova ke zdravému životnímu stylu, s důrazem na spací návyky - intervenční programy...13 Václav Hošek Wellness, well-being a pohybová aktivita Dobroslava Jandová Wellness z hlediska lázeňské medicíny...34 Jan Neuman Wellness a aktivity v přírodě 39 Daniela Stackeová Současné trendy ve fitness cvičení a jejich význam pro wellness 48 Radka Střeštíková a Zora Svobodová Komparace motivace žen k pohybovým aktivitám vybraných věkových skupin 53 Jaroslav Potměšil Welness jako prevence syndromu geriatrické křehkosti..60 Markéta Šauerová Wellnes aktivity v procesu stárnutí

7 PROLOGUE Motto: Concordia Salus Well-being through Harmony (Latin phrase) Latin word Salus 1 translatedusually like "safety", "salvation", "welfare", well-being,in the new scientific content can be covered by the modern term wellness. Still quite newdefinition of the wellness - according WHO - represents a new wide sphere of scientific work. It sounds: Wellness is the optimal state of health of individuals and groups. There are two focal concerns: the realisation of the fullest potential of an individual physically, psychologically, socially, spiritually and economically, and the fulfilment of one s role in the family, community, place of worship, workplace and other settings. World Health Organisation (2000).The world health report Health Systems: Improving Performance.WHO: Geneva. The scientific journal Acta Salus Vitae aims to create a new scientific platformjust for the up defined base of wellness and consequence with health and quality of life problematic. The scientific platform of the journal is open forexperts in field of wellness promotion and service (educationalists, physicians, physiologists, psychologists, etc.). The platform can be divided in 3 areas of research focus: 1. Theoretical foundations of wellness, health and quality of life. Definition of terms and correlation with scientific research. Research methodology in the wellness area. Philosophical and ethical resources. Wellness and sport. 2. Physical, emotional, interpersonal, spiritual aspects of wellness in relation with human health. Wellness in the environmental context, in the school and work environments. 3. Wellness and lifestyle. Principles and problems of protective nutrition. Sleep habits in relation to wellness and quality of life. Adequate movement regime and active lifestyle as a part of wellness and health promotion. Wellness programs and wellness procedures in relation to benefits of the health and quality of life. Wellness - Health - Quality of life, three words very often used in nowadays. The three terms written in the line present a logic continuum and also a path to rich satisfaction in our human being. It is a great honour for me to be in this historic event and to give a few remarksin a key moment of the new scientific journal Acta Salus Vitae. I convey my deepest admiration to all the scientists, which contribute to the high scientific level of the journal and wish themallthe success for their research and for peaceful development of scientific progress. Milada Krejčí Vice-rector for Science and Research College of Physical Education and Sport Palestra in Prague 1 Salus was a Roman goddess. She was the personification of security and well-being (welfare, health and prosperity) of both the individual and the state - 6 -

8 Vědecká studie Yes I Can Exercise Adoption/Adherence Model Petr R. Rehor Camosun College/Pacific Institute for Sport Excellence Interurban Campus, 4371 Interurban Road Victoria, BC, Canada Contact: rehor@camosun.ca Annotation Although other correlates of physical activity among youth have not been clearly established, a growing literature has suggested that social-cognitive factors such as attitudes, social norms and self-efficacy influence the decision to become physically active among youth. The yes i can builds on existing prominent theoretical models employed to study physical activity determinants and provides a curriculum design framework for the development of specific fitness education programs in schools and other educational settings. Key words Adherence, physical activity, health-promoting behavior, self-efficacy. Background The view of physical activity as a health-promoting behavior is gaining recognition throughout the scientific literature. Physical educators across the nation are working to strengthen fitness education curricula, and particularly to find ways to achieve desired outcomes relating to the adoption and maintenance of personal exercise programs beyond school years. Despite the remarkable growth of interest in the effect of physical activity on the incidence of certain diseases, and recent promotional efforts to increase physical activity, national objectives for participation in physical activity (Center for disease Control and Prevention, 1997) have not been met. Physical activity contributes to physiological benefits such as a lower risk of cardiovascular disease (CHD) (U.S. Department of Health and Human Services 2000; Malina 1996), better control of hypertension (Haapanen-Miemi at al. 2000; Hagberg 1997) and diabetes mellitus (Helmrich, Ragland, Leung & Paffenbarger 1991; Shwartz 1997), reduced risk of certain types of cancer (Lee 1994), and lower risk of osteoporosis (Surgeon General s Report on Physical Activity and Health 1996). Physical activity also contributes to psychological benefits such as improving self-esteem and selfconcept (Calfas, Taylor 1997) and reducing depression (Morgan 1994), anxiety, and stress (Surgeon General s Report on Physical Activity and Heralth 1996). Physical activity during leisure time therefore becomes even more important and can contribute greatly to fitness and well-being. It has been shown that increasing the level of leisure time physical activity benefits both men and women as it lessens the mortality risk in both obese and non-obese individuals (Haapanen-Miemi at al. 2000). Whether this physical activity is derived from organized sport or a generally more active lifestyle appears less important than the overall benefits that it can provide. In general, staying active combined with a balanced diet maintains a healthy bodyweight, decreases the risk of CVD and makes a healthier and fitter individual.

9 Vědecká studie Although the health effects of regular physical activity have been well documented, the majority of the western society remains sedentary. Recent surveys conducted in Australia, Canada, England, and the United States indicated that only about 10% of the adult population of each country could be called aerobically active (Stephens & Caspersen 1994). In Australia, during the 12 months ended June 1996, over 5.8 million people (35.5% of the population aged five years and over) participated in organized sport and physical activities. The highest participation rate was exhibited by children aged 9-11 years (71.0%), with the rate declining for each successive age group. The largest falls occurred between year olds and year olds (14.0 percentage points) and between year olds and year olds (12.5 percentage points) (Australian Bureau of Statistics 1998).. The diminishing rates in these age groups coincide with the ages at which people leave school and the years when their interests, preferences and commitments may be changing (Rehor & Cottam 2000). For some time physical educators have recognized the need for fitness education focused on exercise adoption and adherence. While many school districts have made progress in demonstrating gains in student fitness scores, the absence of a comprehensive, theoretically sound curriculum development model, oriented toward change in exercise behavior, has limited the success of school fitness programs. The Yes I Can Exercise Adoption/Adherence Model is offered as a framework for planning instruction focused on long-term commitment to a personal active lifestyle (Figure1). Rational for the Yes I Can Exercise Adoption/Adherence Model The Fitness Education Model focuses on the development of a habit of regular exercise rather than on the enhancement of physical performance. The need for the model grew out of dissatisfaction with our present instructional emphasized in the teaching of motor skills. The majority of today s physical education curricula are designed with the basic assumption that desired changes in fitness participation and performance can be sought in the same fashion as enhancement of motor performance. And yet, our goals and objectives in each of these two major areas are quite different. The primary aim of teaching motor skills is the acquisition of a higher order of movement process skill. Instruction is organized in sequences leading to progressively higher levels of skill. While fitness instruction is sometimes directed toward the attainment of a specific fitness activity participation skill, the main focus of instruction should be on permanent adoption of regular exercise habits. The fitness education construct is of a behavioral nature, structured around personal intentions, individual incentive motivation, and a framework of personal meaning. The Yes I Can Exercise Adoption/Adherence Model The foundations for the model lie in social psychology and in a personal meaning philosophy of education. Social psychologists have provided a number of attitude-behavior models (Godin & Shepard, 1990). The two key concepts of the Yes I Can Exercise Adoption/Adherence Model derived from these models postulate (1) a sequence of behaviors leading from intention to exercise to adherence to a personal exercise program and (2) three categories of factors that influence the intention to exercise. A basic assumption of the Yes I Can Exercise Adoption/Adherence Model is that the development of a regular exercise pattern must begin with the individual s perception of some aspect of personal meaning leading to the intention to exercise. Intentions to exercise are influenced by personal beliefs, social norms, and self-efficacy

10 Vědecká studie Beliefs Personal beliefs about the values and benefits that will follow from exercise participation are considered to be an important factor leading to the intention to exercise. The belief component also includes expectations that performance of exercise will result in the desired outcomes. The perceived consequences of participation are then compared against an individual s predisposed values, such as a desirable lifestyle. Social Norms The second component, social norms, may also be a crucial factor in determining whether an individual develops a positive intention to exercise. Normative belief carries a connotation of self-responsibility and willingness to behave according to personal principles. Unfortunately, at this point in time, regular exercise is not a normative expectation from the social and societal point of view in the way that other aspects of personal health care are. Consequently, motivation to comply may have to be substituted for societal expectations, in influencing the intention to exercise. Furthermore, the motivation to comply may be either strengthened or depressed by the student s perception of the role model and subjective analysis of the importance of compliance in the particular setting. The perceived exercise exertion that will be required also shapes the motivation to comply. Self-efficacy Self-efficacy or perceptions of how easy or how difficult the adoption of a regular exercise regime is likely to be, is the third component that, like personal beliefs and social norms, can influence the intention to exercise. Self-efficacy reflects attitudes about the difficulty of adopting an activity behavior, formed mainly by personal experiences, but also affected by examples of others. It also reflects a personal belief about resources and opportunities available to acquire the desired behavior. These three categories of factors that influence intention to exercise are shown horizontally as the base of the Yes I Can Exercise Adoption/Adherence Model (Figure 1). The sequence of behaviors leading to adherence to regular exercise, or a physically active lifestyle, are represented vertically within the figure. Beliefs, social norms, and self-efficacy influence intention to exercise; intention, to exercise can lead to actual exercise acquisition. The acquisition of regular exercise behavior is viewed as a three-stage process originating with an attempt to exercise, followed by exercise adoption, and terminating with adherence. In addition to factors influencing intentions, and the sequence of behaviors leading to exercise adherence, the Yes I Can Exercise Adoption/Adherence Model includes two other components, attitudes and habit. Attitudes include feelings experiences during exercise participation. Based on the exercise duration, intensity, type, and setting, these feelings can be pleasant or unpleasant, interesting or boring. This component is shaped by the recall of previous experiences, including memories of feelings experienced during earlier attempts to change exercise behavior and during periods of initial adoption of exercise programs. The enjoyment or pleasure experienced during exercising has an important effect, both on selfefficacy and on subsequent intentions to exercise. Habit The biochemical and psychosocial feedback resulting from exercise participation established by past exercise participation at the adherence stage, is now clearly identified as an important determinant of current exercise behavior. The model postulates that adherence to exercise is a habit-forming behavior, deriving either form somatic responses or adaptations or - 9 -

11 Vědecká studie from psychosocial interactions such as belonging or identity. Habit, together with facilitating and reinforcing factors, moderates the predication of exercise adherence from intention. Selection of Instructional Content Present practice in physical education is typically oriented toward the teaching of motor performance skills. The Yes I Can Exercise Adoption/Adherence Model s designed to provide a framework for curriculum development focused on long-term commitment to a personal active lifestyle. In behavioral fitness programs the main focus of instruction should be on permanent adoption of regular exercise habits. Curriculum planners using the Yes I Can Exercise Adoption/Adherence Model take a different approach in selecting the content for physical education classes. Planners address the particular basic components of the model that are appropriate for the personal fitness status and developmental levels of the students in choosing learning activities and instructional techniques. Beliefs If the physical educator is to influence relevant personal beliefs, the curriculum should include provision of knowledge about the benefits of exercise. It should be designed to emphasize demonstrated relationships of regular exercise participation to health, productivity, personal appearance, feelings well-being, and other outcomes valued by the students. Most important, it should foster belief in the likelihood that regular participation really will lead to these desired results. Social Norms Typical adult physical activity patterns, and social expectations in the industrialized world today, do not provide much motivation for young people to development commitment to physically active lifestyles. Consequently, it is especially important that the behavioral fitness curriculum develop effective techniques for self-motivation to exercise. This challenge can be addressed through curriculum content related to planning for supportive environments for desired exercise behavior, to exploring the characteristics of physical activity that make regular exercise attractive and enjoyable for the individual, and to developing the personal attributes that lead to self-motivation (Rehor, 1994). Self-efficacy A number of curriculum strategies are available for helping students to develop positive perceptions about their abilities to acquire the desired exercise behaviors. Teaching students to set personal goals that are both realistic and challenging is basic to many of the other selfregulatory skills for reinforcement of effective and satisfying exercise behavior. Activities selected to strengthen the student s internal locus of control increase the feeling of personal control and the belief that a particular action will lead to the particular outcome sought. A wide variety of self-assessment techniques have been designed and utilized to involve the student in self-testing personal fitness status and progress in self-management. Selfassessment provides both the foundations for sound goal setting and motivation for further achievement. Teaching students that there are effective strategies for exercise adherence helps them to believe in their capabilities for experiencing success in their efforts to develop and maintain active lifestyles. Intentions Every curriculum plan for behavioral fitness education begins with the recognition that the students must be directed toward positive intentions to develop habits of regular exercise

12 Vědecká studie behavior. The standard curriculum approach is to include instruction in designing a sound personal exercise program. Implementation of this component of the Yes I Can Exercise Adoption/Adherence Model is most likely to be successful if instruction includes the planning and monitoring of an exercise program for current use, help in adapting various exercise plans for individual use, and assistance in understanding how personal programs can be modified to adjust to future changes in life circumstances. Exercise Attempt Curriculum planning designed to focus on the attempt component in the three-stage process of acquisition of regular exercise behavior usually employs time management, behavioral contracts, and feedback. Since the most frequently cited obstacle to regular exercise participation is the perception of too little time, instruction suggesting alternative ways to plan time for exercise can be very helpful. Behavioral contracts, which lead the student to agree to meet certain exercise performance standards, are frequently used to encourage students to make serious attempts to exercise. Ensuring positive feedback, especially pleasurable somatic responses to participation, is generally believed to be successful in eliciting future attempts to become involved in regular exercise programs. Exercise Adoption Strategies identified for supporting the adoption of personal exercise programs include rewards, self-monitoring, and stimulus control. The use of rewards, or varied desirable contingencies for providing extrinsic motivation, is a common behavior modification strategy, sometimes used to stimulate exercise adoption. Self-monitoring is an associational learning cognitive behavior modification technique that requires participants to keep records of completion of specific exercise behaviors. Stimulus control is a facilitating and reinforcing technique in which the environment is restructured in order to remove or diminish real or imagined barriers to activity. Exercise Adherence When the individual reaches the stage of actual adherence to a regular exercise pattern, curriculum support for maintaining this achievement can be provided by instruction designed to prevent relapse behavior. This usually takes the form of identifying participation. Identifying these risks in advance, and providing instruction in how to deal with these situations, helps students to avoid the potential relapse. Conclusion In implementing the Yes I Can Exercise Adoption/Adherence Model as a guide for selection of instructional goals and students learning outcomes, curriculum planners need to address the particular basic components of the model that are appropriate for the personalwellness status and developmental levels of the students in choosing learning activities and instructional techniques. Much attention is given to self-assessment, self-monitoring, and other self-management skills. Learning activities are selected to develop the personal attributes that lead to self-motivation. A supportive learning climate is needed to ensure individual success and greater self-efficacy. Students need to develop goal-setting skills and require guidance in learning to set goals that are both realistic and challenging. A wide variety of self-assessment techniques are employed; self-assessment abilities need also to be supported by skills for self-reinforcement

13 Vědecká studie References Australian Bureau of Statistics. (1998). Participation in Sport and Physical Activities, Australia (No ). Canberra, Australian Capital Territory: Author. Centers for Disease and Prevention (1997). Youth risk behavior surveillance United States (MMWR 1998; 47 (SS-3):1-89. GODIN, G., SHEPARD, R. J. (1990). Use of attitude-behavior model in exercise promotion. Sport Medicine, 10(2), HAAPANEN-NIEMI, N., MIILUNPALO, S., PASANEN, M., OJA, P., MALMBERG, J., VUORI, I. Obesity, physical inactivity and low level of physical fitness as determinants of mortality. Medicine and Science in Sport and Exercise. 32 (5): supplement #755, S HEGBERG, J. (1997). Physical Activity, Physical Fitness, and Blood Pressure. In Haskell, W & Leon, A. Physical Activity and Cardiovascular Health, A National Consensus (pp ). Champaign: Human Kinetics. HELMRICH, S., RAGLAND, D., LEUNG, R., PAFFENBARGER, R.J. (1991). Physical activity and reduced occurence of non-insulin dependent diabetes mellitus. New England Journal of Medicine, LEE, I. Physical Activity, Fitness and Cancer. (1994). In Bouchard, C., Shephard, R., & Stephens, T. Physical Activity, Fitness, and Health International Proceedings and Consensus Statement. (pp ). Champaign: Human Kinetics MALINA, R. M. (1996) Tracking physical activity and physical fitness across the lifespan. RQES, 57, MORGAN, W. (1994). Physical Activity, Fitness and Depression. In Bouchard C., Shephard, R., & Stephens, T. Physical Activity, Fitness, and Health International Proceedings and Consensus Statement. (pp ). Champaign: Human Kinetics. REHOR, P. R. (1994). Curriculum Design Model for Secondary Physical Education. In A. E. JEWETT, L. L., BAIN, C. D. Ennis, Curriculum Process in Physical Education, (2nd ed., pp ). Madison, WI: Brown & Benchmark. REHOR, P. R., COTTAM, B. M. (2000). Relationship between the Physical Activity Levels and Screen Watching in Australian Adolescents. Active and Healthy Quarterly. The ACHPER Journal for Physical Educators Health Educators and Fitness Leaders. Vol. 47, 1, STEPHENS, T., CASPERSEN, C. The Demography of Physical Activity. In C. Bouchard, R. Shephard, and T. Stephens (Eds.), Physical Activity, Fitness and Health: International Proceedings and Consensus Statement. South Australia: Human Kinetics SCHWARTZ, R. (1997). Physical Activity, Insulin Resistance, and Diabetes. In Haskell, W., & Leon, A. Physical Activity and Cardiovascular Health, A National Consensus (pp ). Champaign: Human Kinetics. Surgeon General s report on physical activity and health. (1996). From the Centers for Disease Control and Prevention. Journal of the American Medical Association, 276, US Department of Health and Human Services. Healthy people 2010: Understanding and improving health. Washington, DC: U.S. Government Printing Office, 2000; :

14 Vědecká studie Education to healthy life style with the accent to sleep habits intervention programs Tetsuo HARADA, Kai WADA, Osami AKIMITSU, Milada KREJCI, Teruki NOJI, Miyo NAKADE, Hitomi TAKEUCHI 2 Annotation Our research group has went on several intervention programs which were applied to infants, elementary school and junior high school students and university sports-club students and also People who suffered disaster of Hanshin-Awaji Great Earthquake in All intervention programs were performed and are now going on to promote mental and physical health. The current intervention program focuses on the intervention which is based on a newly constructed series-of-leaflets for promoting sleep health entitled Three great benefits due to Go to Bed Early, Get up Early and Do not Forget Breakfast!. These leaflets consists of four versions for parents of small children, athletes, women and people who suffered great disasters. In this keynote lecture, we would like to focus on the results of three intervention studies to promote the athletes who are the members of succor team of Kochi University held in November of 2008 (Takeuchi et al., 2012), 2010 (Wada et al., submitted) and 2011 (Wada et al., unpublished; Harada et al.,. unpublished). All the three kinds of intervention seem to be effective for athletes to change their chronotype into morning-typed one, promote the sleep and mental health and finally improve their performance in playing sports. Key words Healthy life style, sleep habits, intervention programs. Introduction This paper deals with the intervention programs which are educational methods to promote sleep and mental health and improve the sports performance of athletes. The main contents of the intervention are the tryptophan intake at breakfast and following exposure to sun lights. Moreover, incandescent light with lower color-temperature lights as lighting at night is recommended to keep melatonin secretion. The following four paragraphs are theoretical basements of these contents as intervention. Daytime serotonin secretion to be promoted The Tryptophan is an essential amino acid which can be absorbed exclusively from meals in humans. It is metabolized via 5-hydroxytryptamine (serotonin) to melatonin by a series of 4 enzymes in the pineal body (Moore et al., 2000; Zheng et al., 2004). Serotonin is known as a precursor to melatonin. A shortage of serotonin causes depression (including bipolar affective disorder: Mahmood & Silverstone, [2001]), panic disorder, obsessive-compulsive disorder, 2 Harada, T., Wada, K., Akimitsu, O., Takeuchi, H. Laboratory of Environmental Physiology, Graduate School of Integrated Arts and Sciences, Kochi University, Kochi , Japan Krejčí, M. University of Physical Education and Sport Palestra, Pislká 9, Praha 9, Czech Republic Noji, T. Department of Physical and Health Education, Faculty of Education, Kochi University, Kochi , Japan Nakade, M. Department of Nutritional Management, Faculty of Health and Nutrition, Tokai-Gakuen University, Nagoya City, Aichi Prefecture, Japan

15 Vědecká studie sleep disorders and eating disorders (Suzuki, 2000) and induces aggression, anxiety/aggression-driven depression, impulsive behavior and suicidal attempts (Linnoila et al., 1993; Van Praag, 2001; Lindström et al., 2004). Serotonin thus has a strong relationship with mental health. Recently, serotonin reuptake inhibitors (SSRIs) have come to be widely used for the treatment of affective disorders including depression (Taylor & Murray, 2006), although there are controversies whether SSRIs are effective or not for the treatment of depression in children and adolescents because of the shortage of coincident scientific evidences of SSRIs for the young humans (Deniau & Cohen, 2005). Sunlight exposure after the tryptophan intake at breakfast promoting serotonin synthesis Exposure to sunlight in the daytime appears to trigger synthesis of serotonin in the pineal body (Rosenthal et al., 1997). This action is hypothesized to occur mainly in the morning hours, because the amount of tryptophan consumed with supper has neither significant effects on Morningness-Eveningness (M-E) scores nor an effect on sleep habits, as shown by another study on young Japanese children performed in 2005 (Harada et al., 2012). Serotonin synthesis can be promoted by the exposure to sunlight after taking breakfast Tryptophan intake at breakfast is effective for the onset and offset of sleep in young children (Harada et al., 2007). Moreover, questionnaire surveys showed that young children exposed to sunlight for more than 30 minutes after having sources of protein at breakfast are more morning-typed than those exposed for less than 30 minutes (Nakade et al., 2009), and that the more young children take vitamin B6 at breakfast, the more they exhibit morning typology (Nakade et al., 2012). Melatonin synthesis from serotonin can be suppressed by evening lights with high color temperature from fluorescent lamp Melatonin is synthesized in the pineal body of the hypothalamic area and secreted at night. Melatonin level at serum can be well and positively correlates with that at saliva level (Laakso et al., 1990; Nagtegaal et al., 1998; Peuhkuri et al., 2012). Secretion of melatonin exhibits circadian rhythms and is suppressed by bright light (Burgess et al., 2001; Kubota, 2002). Even room lights such as fluorescent lamps can attenuate melatonin excretion duration at night (Harada, 2004; Gooley et al., 2011). This evening lights might include lights with high color temperature from the monitor of PC, TV-game, and mobile phone. These lights from the monitor are possible to delay the circadian phase, depress the melatonin level at night and reduce the sleep quality, although there have been only a few studies on the effect such lights on circadian phase (Harada et al., 2004) and REM sleep reduction (Higuchi et al., 2005). The relationship between physical activities and sleep have been studied from a view-point of effective method as physical training and activities to promote sleep health. For example, thirty minutes of running in the morning during weekdays for 3 consecutive weeks impacted positively on sleep and psychological functioning in healthy adolescents (18 yrs old, half females) living in Switzerland compared with control subjects (no running trainings) (Kalak et al., 2012). Another Switzerland study on adolescents aged 17.2 years on average showed that compared with controls (4.69 hours physical-training per week), athletes (17.69 hours) reported better sleep patterns including higher sleep quality, shortened sleep onset latency, and fewer awakenings after sleep onset, as well as less tiredness and increased concentration during the day (Brand et al., 2010). Atkinson and Davemme (2007) introduced in their review paper a number of physiologic relationships between the behaviors of sleep and exercise, and emphasized that the appropriate transition period between physical activity and sleep onset

16 Vědecká studie might be important for ensuring good sleep quality. However, there have been no challenges on whether promotion of sleep health via shifting to morning-typed life can improve the sports performance of athletes. This intervention program tries to promote the morning-typed life of athletes and this chronobiological approach challenges to improve the mental and sleep health and finally the athletes performance. Three interventions for athletes 1. The first intervention to athletes, breakfast contents and following exposure to light (Takeuchi et al., 2012) This study was performed to clarify whether a combined intervention of the consumption of Tryptophan and Vitamin B6 at breakfast plus sunlight exposure after breakfast could effectively increase morningness in the participants of Japanese University sport club members (Fig. 1). breakfast (protein VB6) tryptophan Sun light exposure Better mental health serotonin(antidepressant) melatonin(agent to fall sleep) (Harada et al., 2007; Nakade et al., 2009) Better sleep health Fig. 1: Schematic presentation of the theoretical mechanism of tryptophan consumption at breakfast and following exposure to sunlight to promote the sleep and mental health. The students were divided into three groups with equal numbers of the different chronotypes to eliminate bias. Participants in Group 1 (G1) had no intervention. Participants in Group 2 (G2) were asked to eat protein resources such as fermented soybeans and Vitamin B6 resources such as bananas at breakfast and were also asked to record their breakfast contents. Participants in Group 3 (G3) were asked to do the same as G2 plus expose themselves to sunlight after breakfast and record the exposure duration. Evening-typed participants who occupied 50% of all participants before the intervention in G2 and G3 significantly shifted to more morning-typed (Fig. 2) two months after the intervention. For the evening-typed participants who occupied 50% of all participants in G2 and G3, a significant and positive correlation was shown between the change in Trp amount consumed at breakfast and the change in M-E score (more Trp consumption and shifting to morning-type) before and after intervention (Fig. 3). Based on the correlation analysis, the

17 Vědecká studie consumption of Trp at breakfast might be hypothesized to cause a shift in circadian typology of university students to be more morning-typed. Individual comparison between before and after the intervention G1 G2 & G3 morning type evening typed morning type evening typed n.s. p = n.s. n.s. become worse not change improved Change of ME score every students 0% 20% 40% 60% 80% 100% ME score(mean, s.d.) p =0.03 before after Evening type (50%) Morning type(50%) Evening type (50%) Morning type(50%) G1 G2 & G3 Fig. 2: Half of the students who were evening-typed in the ME distribution before the intervention in G2 and G3 shifted to more morning-typed after the intervention. (Wilcoxon signed-ranks test: z=-2.19,p=0.03).before: before intervention ; After: 2 months after intervention : Mean Before : Mean After (Takeuchi et al., 2012)

18 Vědecká studie Change of M-E score (After - Before) (mg) Change of Trp intake from breakfast (/1week) Fig. 3: Correlation between change of M-E score and Trp value from breakfast (G2 & G3) Sleep quality (Monroe, 1967) was significantly improved after the intervention in G3 (p=0.03) and tended to be so in G2 (p=0.08), while it was similar to that before intervention in G1 (p=0.28). The frequency to become angry or irritated was lower after intervention than before it in G 2 (p=0.02) and G3 (p=0.049), whereas there was no difference in the mental health in G1 (p=0.94). 2. The second intervention to athletes as breakfast contents, following exposure to light and using orange-color lights from light-bulbs as night lighting (Wada et al., submitted) The correlation between tryptophan rich breakfast and following exposure to sunlight and the morning type of Japanese infants (Harada et al., 2007) can be based on the following hypothesis. A high concentration of serotonin in the brain and high concentration of plasma melatonin at night can induce earlier fall-in-sleep (Fig. 1)

19 Vědecká studie breakfast (protein VB6) tryptophan Sun light exposure Better mental health serotonin(antidepressant) melatonin(agent to fall sleep) (Harada et al., 2007; Nakade et al., 2009) Better sleep health Fig. 1: Schematic presentation of the theoretical mechanism of tryptophan consumption at breakfast and following exposure to sunlight to promote the sleep and mental health. However, this high melatonin-concentration can be depressed by the fluorescent lamps which are being used by most of all Japanese homes. The intervention consisted of, first, having breakfast with protein- and vitamin B6- rich foods and, second, exposure to sunlight after breakfast plus exposure to incandescent light (low temperature light) at night (October- November, 2010). Participants as university soccer club members of 94 (2010) were divided into 3 groups for the intervention (G1[Photo 1-A]: no intervention; G2[Photo 1-A]: asked to have protein-rich foods such as fermented soybeans and vitamin B6-rich foods such as bananas at breakfast and sunlight exposure after breakfast; G3[Photo 1-B]: the same contents as G2 and incandescent light exposure at night). Melatonin in salivary collected was measured around 11:00 p.m. at a mid-point and on the last day of the 1 month intervention. In G3, there was significantly positive correlation between total hours when the participants spent under incandescent light at night and the frequency to feel deep sleep (p=0.034) during the last week. The salivary melatonin concentration of G3 was significantly higher than the melatonin level of G1 and G2 in combined salivary samplings at the mid-point and on the day just after the 1 month intervention (p=0.018) (Fig. 4-A), whereas no such significant differences were shown on the day just before the start of the intervention period (p=0.63) (Fig. 4-B). The integrative intervention on breakfast, morning sunlight and evening-lighting may be effective for students including athletes to keep higher melatonin secretion at night which seems to induce easy introduction of the night sleep and higher sleep-quality

20 Vědecká studie A B Photo 1: Examples of night time lighting for Group 1 and Group 2 (A) and Group 3 (B) during the intervention 1 month. (A): fluorescent lamp with higher color-temperature lights; (B): Incandescent light with lower color-temperature lights

21 Vědecká studie Fig. 4: Comparison of salivary melatonin concentration among the three groups. Group 1: no intervention; Group 2: Recommendation of high protein breakfast andexposure to sunlight; Group 3: Same as Group 2 plus the recommendation of exposure to low color temperature light emitted from an incandescent light bulb. A: Melatonin level in the saliva collected on the day just before the intervention (Kruskal Wallis test: χ 2 - value=0.92, df=2, p=0.63); B: Melatonin in the saliva collected at the mid-point and on the day before the last day of the intervention(bonferroni multiple comparison test: mg1 versus G3, p=0.018; G2 versus G3, p=0.011)

22 Vědecká studie 3. The third intervention to athletes using the leaflet (Harada et al., 2011) for athletes three benefits for athletes due to Go to Bed Early, Get up Early and Do not Forget Breakfast! (Wada et al., unpublished; Takeuchi et al., unpublished) All soccer team members were asked to follow the contents of the leaflet for athletes three benefits for athletes due to Go to Bed Early, Get up Early and Do not Forget Breakfast! for one month of mid November to mid December Integrated questionnaire was administered before the intervention, just after the intervention and three months after the intervention. During one month intervention, sleep diary and meal contents survey were applied to the participants every day. Just after the intervention, the number of days when they could follow each of the seven contents (1. Exposure to sunlight early in the morning, 2. Exposure to sunlight after breakfast, 3. Exposure to orange-colored lights from light bulb as night lighting, 4. Consumption of protein resources at supper, 5. Limitation of using TV-Game at night, 6. Limitation of using PC at night, 7. Limitation of watching TV at night) of intervention was recorded. Change in each of 11 elements of performance quality (Table 1) from the beginning of intervention was subjectively evaluated at one month later. The sum of change-values in 11 elements was presented as index of change in soccer-performance quality. The soccer team members were divided to three groups which were ranked in accordance with total performance ability (G1: ranked the first, G2: the second and G3: the third). Table 1. Question: How was your current soccer performance which could be evaluated by 11 elements, changed in comparison with that just before the intervention period?. Improved Receded 1. Judgment of 1Quicker 2a little bit quicker 3 a little bit delayed 4 delayed the situation in play 2. Field of vision in play 1 Broader 2 a little bit broader 3 a little bit narrower 4 narrower 3. Moving legs felt 1 heavier 2 a little bit heavier 3 a little bit lighter 4 lighter in play 4. The first touch 1 more skillful 2slightly more skillful 3 slightly less skillful 4less skillful to the ball 5. Rudimentary errors 1 decreased 2 a little bit decreased 3 a little bit increased 4 increased 6. Irritation in play 1 decreased 2 a little bit decreased 3 a little bit increased 4 increased 7. Shortage of stamina 1 decreased 2 a little bit decreased 3 a little bit increased 4 increased 8. Injury in play 1 decreased 2 a little bit decreased 3 a little bit increased 4 increased 9. Body balance in play 1 improved 2 a little bit improved 3 a little bit receded 4 receded 10.Precision of long kick 1 higher 2 a little bit higher 3 a little bit lower 4 lower 11.Motivation for training 1 higher 2 a little bit higher 3 a little bit lower 4 lower

23 Vědecká studie There was significant positive correlation between the index of improvement of soccerperformance quality and the sum-index of how many days each participant followed each of seven contents of intervention (p=0.003) (Fig. 5). Worse (R²=0.182) Better Total index of implementation of 7 kinds of intervention issues for one month Fig. 5: The implementation of 7 kinds of intervention issues for one month seems to be effective for improvement of soccer performance (Pearson s correlation test: r= , p=0.003). In the G1 showing highest performance, there was significant positive correlation between the scores of the diurnal type scale and the index of performance improvement (Morningtyped participants showed improvement of performance) (p=0.003). In G3 which ranked the third in accordance with total performance ability, mental health was improved by the no usage of PC at night during the intervention period of one month (Pearson s correlation test: r=0.64, p=0.001, n=22)(fig. 6)

24 Vědecká studie Fig. 6: Mental health was improved by the no usage of PC at night during the intervention period of one month in the soccer team, as Group 3 which ranked the third in accordance with total performance ability (Pearson s correlation test: r=0.64, p=0.001, n=22) (GHQ: The General Health Questionnaire) Improvement of mental health indicated by irritation and anger, due to the intervention for one month was mainly shown in G1 and G2 (Fig. 7) , , , Before intervention After intervention 5.8 5, , , , G1 G2 G3 In total

25 Vědecká studie Fig. 7: Improvement of mental health on irritation and anger due to the intervention for one month. The improvement was significant only in the soccer team, Group 2 which ranked the second in accordance with total performance ability (Wilcoxon-test: Group 1 which ranked the first, z=-1.651, p=0.099; Group 2, z=-2.126, p=0.033; Group 3 which ranked the third, z=-1.365, p=0.172) Significant improvement was shown only in G2 which ranked the second in accordance with total performance ability (Wilcoxon-test: Group 1 which ranked the first, z=-1.651, p=0.099; Group 2, z=-2.126, p=0.033; Group 3 which ranked the third, z=-1.365, p=0.172) (Fig. 7). Discussion and conclusion The first two interventions and the third intervention using this leaflet would be effective to improve the performance of athletes via changing them into the morning-typed persons. The improvement of sports performance is based on the following three physiological mechanisms. 1. Sufficient growth hormone secretion due to early bedtime can repair the physical damage due to training, and athletes could have healthful physical conditions in which they are hard to be injured during training and game. Growth hormone secretion peak has been coincided with the appearance of deep Non- REM sleep with slow wave due to EEG, and growth hormone releasing hormone can decrease wakefulness and increase SWS in human and rats (Cauter & Plat, 1996). These two phenomena were enhanced by cortisol application (Bohlhalter et al., 1997). This means Go to bed early promotes higher secretion of growth hormone in athletes. Saceda et al. (2011) reported that growth hormone application promotes the peripheral nerve regeneration in rats. In general, growth hormone seems to accelerate immunological power (Hattori, 2009) and the repairmen of peripheral organs in adult humans. 2. New skills fixation as memory in the brain during REM sleep at the following night REM sleep has a function of the fixation of memorized issues in the brain (Fogel et al., 2007; Smith, 2012). Skills in sports which are newly taken during the training could be fixed in the brain during REM sleep in the last half of the sleep hours in the next night of the training day. 3. High concentration of serotonins in the brain daytime which can promote the concentration on the play in the training an game for the athletes. The protein rich breakfast and following exposure to sunlight can promote the serotonin synthesis in the brain in the morning and the serotonin seems to increase the concentration on the play during the training and game. The results of the three intervention studies on soccer team members of Kochi University showed the possibility to improve the performance of sports through promoting sleep health and morning-typed life. Detailed 7 contents in the leaflet would be powerful for promoting physical and mental health of athletes in the world